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THE SIDE EFFECTS OF CHEMOTHERAPY

You will hear many stories about the side effects of chemotherapy from well
meaning (though often ill informed) people. There are numerous
chemotherapy drugs, used in different regimens for different cancer types.
Each person reacts differently to chemotherapy. Prior to commencing
chemotherapy you will be requested to attend a pre-admission clinic with one
of our nursing staff. You are encouraged to bring a family member or friend to
this education session. In this private session you will be given information
regarding each individual chemotherapy drug you are to receive, the possible
side effects and the management of those side effects.
Remember that the side effects listed are only the worst case scenario –
they may not necessarily happen to you.
Chemotherapy drugs are designed to kill cancer cells; however some normal
cells are also damaged in the process
Blood cells (red cells, white cells and platelets) are often affected by
chemotherapy. You will be required to have regular blood tests throughout
your treatment. You DO NOT need to call the NCI for the results; a member
of our oncology team will contact you if there is a problem with your blood
results.
Platelets help your blood to clot. A low platelet count is a common side effect
of many chemotherapy drugs. Symptoms usually include bruising and
bleeding (although not life threatening).
Anaemia (low red cell count) can also occur and the side effects you may
experience in relation to this include shortness of breath on exertion,
palpitations and lethargy requiring you to rest often. In the event that you
develop a low red cell count, the nursing staff will discuss this problem with
your oncologist, and you may be offered a blood transfusion (which is
provided in the NCI).

Chemotherapy also commonly lowers your white blood cells (the cells that
fight infection). This may happen approximately 10 – 12 days after each
treatment. If you have a temperature greater than 38 ºC, twice in a 6 hour
period, please contact your General Practitioner, or attend the Accident &
Emergency Department of Royal North Shore Hospital, or the hospital nearest
to you. If you attend the emergency department of any hospital, you should
take your NCI appointment card with you.


NAUSEA AND VOMITING

Nausea (feel like vomiting) and vomiting can be caused by several factors:

Nausea is a common side effect of many chemotherapy drugs. Nausea is
much easier to prevent than treat and it is strongly advised you take the
anti-nausea drugs you have been prescribed, as directed. Anti-nausea drugs
are given before each chemotherapy treatment and can be continued for as
long as necessary - this may vary from one to several days post
chemotherapy.
Dependant on your chemotherapy regimen, specific anti-nausea drugs will be
prescribed for you to take. There are several different ways in which anti-
nausea drugs work, and there are several alternatives that can be offered:

Aprepitant – Emend tripack: 125mg capsule, 2 x 80mg capsules
Take 125mg capsule one hour prior to chemotherapy; then take one 80mg
capsule daily, starting the day after chemotherapy, for 2 days.
Tropisetron - Navoban
Given intravenously day of your chemotherapy; then take one 5mg capsule
daily, starting the day after chemotherapy, for 2 days.
Granisetron – Kytril
Given intravenously on the day of your chemotherapy; then take one 2mg
tablet daily, starting the day after your chemotherapy, for 2 days.
Ondansetron - Zofran
Given intravenously on the day of your chemotherapy; then take
one 8mg tablet twice a day, starting the night of chemotherapy, for a total of 4
doses.
Dexamethasone - Dexmethasone
Given intravenously on the day of your chemotherapy. Take one 4mg tablet
morning and midday, with food, for 2 days following chemotherapy (only if
instructed to do so)

Metoclopramide - Maxalon (Pramin) 10 mg tablet
Take 1-2 tablets every 4-6 hours if you are nauseated. You may find it helpful
to take one tablet half an hour before meals if you are nauseated
Prochlorperazine - Stemetil 5 mg tablet
Take 1-2 tablets every 6-8 hours if you are nauseated. You may find it helpful
to take one tablet half an hour before meals if you are nauseated
Prochlorperazine - Stemetil suppository 25 mg
Insert one rectally every 6-8 hours. These are excellent if vomiting is an
ongoing problem

Some people have mild continuous nausea despite taking anti-nausea drugs.
If this occurs then try:
• An antacid such as Zantac 150mg, one tablet twice a day.
• Pyridoxine 100 mg (Vitamin B6), one tablet, twice per day.
• Ginger capsules, one capsule, 3 times a day may also be helpful.
Remember - everyone is an individual and responds differently to treatment. If an anti-nausea drug does not work for you, there are always other alternatives you can try. Please also note that differing anti-nausea drugs can be taken at the same time. Please discuss this with your oncology team. Make meals work for you.
As a cancer patient good nutrition is VERY IMPORTANT, as your dietary needs are greater at this time. Choosing a variety of foods from each of the five food groups will ensure you have a well balanced diet, in order to provide your body with all the essential nutrients it needs. This will help you cope mentally and physically with the cancer and any treatment side-effects, allowing you the best possible response to your treatment. A dietician can assist you with nutritional information, if required. Some useful hints to prevent/alleviate nausea
Don’t have a large meal immediately before or after chemotherapy treatment Eat your main meal at the time of the day when you feel your best Cook food before nausea occurs, or alternatively, have someone else prepare your meals. Plain (rather than spicy) foods may be better tolerated Take sips of fluid often, this is important to keep you well hydrated Avoid excess coffee and tea as these may stimulate your stomach to feel more unsettled You should drink 2-3 litres of fluid a day for 2-3 days immediately
following chemotherapy.

ANTI-EMETIC REGIMEN

Morning Lunch

Day of chemo

Day 1 post
chemo
Day:

Day 2 post
chemo
Day:
BOWEL PROBLEMS
CONSTIPATION

The anti-nausea drugs, Navoban , Kytril and Zofran, as well as some anti-
cancer drugs can cause constipation.
It is recommended that you commence an aperient (laxative) the day your
chemotherapy starts. You should continue taking the aperient until you have
finished your course of anti-nausea drugs and your normal bowel habits have
been re-established.
If constipation persists, contact your GP or the NCI. No more than 2 days
should pass without a bowel motion.
Some suggestions to prevent or relieve constipation include:
Include high fibre foods in your diet (e.g. bran, raw fruits & vegetables, whole grain breads & nuts) Maintain a normal level of activity or exercise, if possible Faecal softeners or other aperients will almost always be required. If you have a history of constipation, start taking an aperient the night before chemotherapy Coloxyl with Senna - Take 1-2 tablets at night. If necessary, the
tablets can be taken up to 3 times a day.
Movicol sachets – Mix 1 sachet in 125 – 250mLs of water. A
maximum of 8 sachets per day can be taken.
If your bowels have not opened by the evening of the second day, try a Senna Milkshake. Senna Milkshake: 1-2 teaspoons of Senna granules and 10-20 mls of
Agarol. Mix into a paste with a little hot water. Add milk and a scoop of
icecream. Shake well. (This mixture tastes just like a chocolate
milkshake).
If, despite the above, your bowels still have not opened by midday the third day, try one glycerine and one Durolax suppository inserted in the rectum. If this still does not work, contact your GP. DIARRHOEA

Diarrhoea can be caused by some chemotherapy drugs, or by anxiety. If
diarrhoea continues for more than 24 hours or if you are experiencing pain or
cramping, please see your local doctor as it may be necessary to exclude a
viral or bacterial infection.
Some ways you may be able to control diarrhoea include:

Drink small amounts frequently to replace fluids you have lost Drink clear fluids such as weak apple juice, water, weak tea or clear broth. Gastrolyte or Powerade are often useful to replenish electrolytes that may be lost The fluids should be taken at room temperature or warmed. Let carbonated drinks lose their fizz before you drink them. Eat smaller amounts of food but eat more frequently Try plain foods instead of spicy or fried foods Alcohol, fruit juices and strong tea or coffee may stimulate the bowel so these should be avoided where possible Imodium or Gastro Stop - Take 2 capsules initially, then take 1
capsule after each loose bowel motion, but do not exceed 8 capsules
in any 24hr period. If diarrhoea continues, contact your doctor.
Lomotil - Take 1 tablet after each loose bowel motion. If diarrhoea
continues, contact your GP.

MOUTH CARE

Some chemotherapy drugs can cause a dry, sore and/or ulcerated mouth, as
well as taste changes. To prevent infections occurring and maintain a healthy
mouth environment, it is important to keep your mouth clean during your
treatment.
Use a soft, small headed toothbrush which must be rinsed well after every use Gently brush your teeth after each meal using circular stroke. Use a mouthwash at least 4 times a day. We recommend sodium bicarbonate mouthwash (Dissolve 1 teaspoon of bicarbonate soda in a glass of warm water. Rinse your mouth well, then spit out. Use after each meal and before going to bed) Avoid commercial mouthwashes that contain alcohol, as they will dry and irritate your gums If you have dentures, remove and clean them after each meal. Rinse your mouth with mouthwash when your dentures are removed
Suggestions for managing taste changes

Maintain good oral hygiene with regular tooth brushing and by using mouthwash at least 4 times a day Eat mints (or sugarless mints) or chew gum (or sugarless gum) to mask a bitter or metallic taste Use plastic utensils if food tastes like metal
Treatment for a dry mouth

Chew sugarless gum or suck on sugarless lollies to stimulate saliva flow Avoid caffeine, alcohol and tobacco, as these can dry out the mouth Apply Biotene Oral Balance Moisturising Gel to the mouth and/or tongue. Alternatively you can try Toothette mouth moisturiser Use a lubricant such as paw paw ointment or oralife peppermint lip treatment on the lips if they become dry
Treatment for a sore mouth, ulcers or infections

Check your mouth every time you do your mouth care. If you develop a sore
mouth or a white coating on your tongue, use a Sodium bicarbonate,
Biotene, or Difflam mouthwash every 2-4 hours.
You must also use:

Nilstat antifungal drops. Swish 1mL around your mouth, then swallow. These can be purchased from your local pharmacy and do not require a prescription. Fungilin lozenges or Fluconazole tablets can also be used. Both require a prescription from your GP.
You should also:

Use Biotene toothpaste if regular toothpaste irritates your gums Avoid
Acidic foods (e.g. Grapefruit, oranges, lemons and tomatoes) If you have mouth pain

Xylocaine viscous fluid 5 mls – hold in mouth for as long as possible
spit out. Avoid eating hot foods after this procedure.
Gelclair – empty 15mL sachet into a glass and add up to 3
tablespoons of water. Rinse around mouth and tongue, then spit out.
For an individual ulcer, try Kenalog in Orabase Paste
If the infection or mouth ulcers do not start to improve after 24-48 hours, or if the pain interferes with your ability to eat and drink, please consult your GP or the NCI. YOUR LIFESTYLE

A healthy life style assists with recovery and aids in coping with the illness
and the side-effects of your treatment.
Ensure you:
Get as much regular exercise as possible This will help take your mind off your illness and ensure you maintain your overall quality of life.
Chemotherapy and its associated side effects may impinge upon / affect your
sexuality. Therefore, whilst undergoing chemotherapy please do not hesitate
to discuss any concerns you may have with your oncology team
Following chemotherapy administration, all of your body fluids are
contaminated with chemotherapy for several days. Excretion times – the time
it takes for your body to excrete or remove the chemotherapy, varies. Your
oncology team will inform you about the excretion time for the drugs you
receive.

During this excretion time you should protect your partner by using safe sex
techniques (e.g. condoms) and, when using the toilet, close the lid and double
flush after each use.
NB: Carers should wear gloves when handling any body fluids.

COMPLIMENTARY THERAPIES
Please discuss any complimentary therapies with a member of the oncology
team. Some drug therapies you may wish to pursue while you are receiving
chemotherapy can occasionally interfere with your treatment.

Source: http://www.northshoreprivate.com.au/northern-cancer-institute/documents/side%20effects%20of%20chemotherapy.pdf